Temporomandibular Joint Dysfunction

Temporomandibular Joint Dysfunction or TMJD is a common malady affecting millions throughout the world. According to statistics most sufferers are women. I believe the reason for this is, that in many cultures women are not allowed to express their anger, and as a consequence, it somatizes in the jaw. We do know that suppressed anger and stress contribute greatly to TMJD. Most jaw clenching occurs at night but can also happen on an unconscious level throughout the day. In my experience, treatments like EMDR, are very effective for the psychological aspects of  TMJD. The physical causes include malocclusion, improper orthodontia, cranial trauma at birth, whiplash, and of course any blows to the jaw. Standard treatments include night guards, oral appliances, adjusting tooth height, orthodontia, cranial osteopathy, physical therapy, and chiropractic. It is my contention and experience that these treatments would be more effective if they included a method to make  the jaw muscles less facilitated/reactive to other muscles and functions throughout the body.

Symptoms of  TMJD include jaw pain, headaches (especially around the eyes), neck pain, and tinnitus (ringing in the ears). Tinnitus often is caused by a hyperactive lateral pterygoid muscle which has fibers that connect to the inner ear. But to treat the jaw as if it existed without any connection to the rest of the body is to do it a great injustice. Let’s explore some of the basic and more complex relationships. Mastication is a very complex movement. It involves movement superiorly, inferiorly, anteriorly, posteriorly, medially and laterally. All of these planes of motion affect other muscles throughout the body creating similar planes of motion. Jaw opening creates superior, inferior, anterior, and posterior movement. Chewing adds the medial and lateral components. I will first address the four major muscles of mastication: the temporalis, the masseters, the medial pterygoid, and the lateral pterygoid.

NeuroKinetic Therapy views the jaw muscles as a default mechanism for overcompensation. In other words, the jaw muscles can become facilitated for other inhibited muscles throughout the body. The temporalis muscle can compensate for muscles along the Front Line, including the neck flexors, pectorals, abdominals, hip flexors, and dorsiflexors. Due to its interesting configuration, the temporalis muscle can also compensate for muscles along the Back Line. These include the spinal muscles, the gluteals, the hamstrings, and the plantarflexors. The masseters, the strongest muscle in the body for its size, affects the Front Line and Back Line in a similar fashion. This muscle is capable of medial and lateral translation of the jaw, creating ipsilateral lateral movement. Thus it can affect muscles that side bend the neck, side bend the torso, hip abductors, and the peroneals. Both the medial and lateral pterygoids create contralateral lateral movement of the jaw. Therefore they can affect the same muscles as the masseters, only on the opposite side.

Some good examples of these relationships are as follows. The temporalis often compensates for inhibited neck flexors and gluteals. The masseters often inhibit those same muscles and the hip flexors. The pterygoids often inhibit the scalenes, the latissimus dorsi, the obliques, the quadratus lumborum, and the hip abductors. If these relationships are left unattended the tension in the jaw muscles increases tremendously resulting in the aforementioned symptoms. Remember that the tension in these muscles is a result of a faulty relationship with other muscles/functions. To simply release these muscles without first figuring out what they are compensating for, could result in destabilizing functional integrity. Treat the cause not the symptoms.

The muscles of the floor of the mouth can also compensate globally, but I find them most involved in bracing with the diaphragm and the pelvic floor muscles, similar to the Valsalva maneuver. This kind of “bearing down” is a very common compensation pattern often involved with emotional issues. When treating the muscles of the floor of the mouth, it is important to consider the diaphragm and pelvic floor muscles. Clenching, breath holding, and anal tightening are common reactions to stressful situations which can result in developing dysfunctional movement patterns. These can often be the missing pieces to solving long-standing puzzles.

Successful treatment of  TMJD  must include a consideration of the global relationships between the jaw muscles and the rest of the body.